Pharmacy—Acceptance of rules and fees.
(1) Acceptance and filling of a prescription for a worker entitled to benefits under the industrial insurance law, constitutes acceptance of the department's rules and fees.
(2) When there is questionable eligibility, (i.e., no claim number, prescription is for medication other than usually prescribed for industrial injury; or pharmacist has reason to believe claim is closed or rejected), the pharmacist may require the worker to pay for the prescription.
(a) The pharmacist must furnish the worker with a signed receipt and a nonnegotiable copy of the prescription including national drug code and quantity or a completed department pharmacy bill form signed in the appropriate areas verifying worker has paid for the prescribed item(s) in order for the worker to bill the department or self-insurer for reimbursement.
(b) The worker may not be charged more than the amount allowable by the department or self-insurer.
(c) The worker must submit such reimbursement request within one year of the date of service.
See WAC 296-20-020
for details on providing a refund.
(3) Pharmacies may bill the department for initial prescription drugs prior to claim acceptance upon the presentation to the pharmacy of a state fund identification card or a copy of the Report of Industrial Injury or Occupational Disease.
[Statutory Authority: RCW 51.04.020
, 51.04.030 and 2007 c 134. WSR 08-02-021, § 296-20-170, filed 12/21/07, effective 1/21/08. Statutory Authority: RCW 51.04.020
. WSR 03-21-069, § 296-20-170, filed 10/14/03, effective 12/1/03. Statutory Authority: RCW 51.04.020
, 51.04.030 and 1993 c 159. WSR 93-16-072, § 296-20-170, filed 8/1/93, effective 9/1/93. Statutory Authority: RCW 51.04.020
(4) and 51.04.030. WSR 86-06-032 (Order 86-19), § 296-20-170, filed 2/28/86, effective 4/1/86. Statutory Authority: RCW 51.04.020
(4), 51.04.030, and 51.16.120(3). WSR 80-18-033 (Order 80-24), § 296-20-170, filed 12/1/80, effective 1/1/81; Order 76-34, § 296-20-170, filed 11/24/76, effective 1/1/77.]